SESSION TITLE: Pulmonary Manifestations of Systemic Disease Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder worldwide. While thoracic complications are frequent in CLL, only limited data exist regarding the types and etiologies of these complications. Pleural, parenchymal, and airway disease may occur due to the CLL itself, chemotherapy or biologic agent adverse events, typical or opportunistic infections, or from pre-existing comorbidities. These thoracic complications may be increasing due to the advancements in treatments and the prolongation of life. We aim to review the thoracic complications in a large cohort of CLL patients admitted to a tertiary care medical center.
METHODS: Retrospective chart review of all patients admitted from 2001 through 2014 with a diagnosis of CLL and one or more thoracic complications.
RESULTS: 277 patients with CLL and thoracic complications were admitted 409 times. Seventy percent of patients had received prior treatment with the majority receiving more than one agent. The most common diagnosis was pneumonia, 257/409, (62.8%), of which 115/257, (45%) had an etiologic diagnosis. Gram-positive infections were found in 55 cases, with pneumococcus being the most common. Gram-negatives accounted for 29 of the identified organisms and another 16 were of viral etiology. Fungal infections were found in 20 patients, with 8 cases of pneumocystis and Aspergillus each. Non-infectious complications included primary leukemic infiltrates in 24/277, (8.6%), malignant effusions in 20/407, (4.9%) of which 2/3 were flow cytometry positive for CLL. Pulmonary embolism, or deep vein thrombosis, was found in 16/277, (5.8%), and organizing pneumonia in 4/277, (1.4%). Additionally 14/409, (3.4%), had Richter’s transformation and 28/409, (6.8%), had a new primary lung cancer. 138 invasive procedures were performed on 83 patients over 100 visits and 75% yielded a definitive diagnosis.
CONCLUSIONS: Thoracic complications due to CLL itself or from drug toxicity are prevalent and may be mistaken for more typical causes of lung disease. While infections, particularly pneumonia, were the most common diagnosis, other etiologies are being seen with increasing frequency.
CLINICAL IMPLICATIONS: Newer treatment regimens and intrinsic immune dysregulation predispose CLL patients to thoracic complications, which are now more prevalent due to the longer life expectancy. Heightened awareness of the increasing incidence of CLL related thoracic disease might decrease the time to correct diagnosis and lead to improved outcomes.
DISCLOSURE: The following authors have nothing to disclose: Sameer Khanijo, Pragati Tandon, Seth Koenig
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